Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis
Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis
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DOI：
10.1016/s0140-6736(05)66457-4
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发表时间：
2005-04-30
期刊：
影响因子：
168.9
通讯作者：
Tisch, DJ
中科院分区：
文献类型：
--
作者：
King, CH;Dickman, K;Tisch, DJ
血吸虫病是世界上最流行的传染病之一，但其对全球疾病负担的影响存在争议。已公布的残疾调整生命年（DALY）估计表明，血吸虫感染的平均影响相当小，尽管这是有争议的。为了对血吸虫病相关残疾进行循证重新评估，我们对所有形式血吸虫病的残疾相关结局数据进行了系统回顾。方法采用EMBASE、PUBMED、Cochrane等电子数据库进行结构化检索。人工检索已发表的参考书目，通过联系研究小组获得未发表的研究。报告由两名训练有素的读者独立审阅和摘要。所有关于血吸虫病发病率的随机和观察性研究均符合纳入条件。我们使用分类结果的加权优势比和连续数据的标准化平均差异来计算报告的残疾相关效应的汇总估计。研究结果筛选了482篇发表或未发表的报告（1921年3月至2002年7月）。在入选的135项研究中，51项提供了与表现相关的症状数据，而109项报告了观察到的与残疾相关的发病率。血吸虫病与贫血、慢性疼痛、腹泻、运动不耐受和营养不良显著相关。与世卫组织估计的0.5%的残疾权重分配给血吸虫病相比，2-15%的残疾似乎在血吸虫病患者的不同功能领域很明显。如果在正式的患者偏好研究中得到证实，这一提高的估计表明需要重新评估我们治疗这种无声的血吸虫病大流行的优先事项。
Background Schistosomiasis is one of the world's most prevalent infections, yet its effect on the global burden of disease is controversial. Published disability-adjusted life-year (DALY) estimates suggest that the average effect of schistosome infection is quite small, although this is disputed. To develop an evidenced-based reassessment of schistosomiasis-related disability, we did a systematic review of data on disability-associated outcomes for all forms of schistosomiasis.Methods We did structured searches using EMBASE, PUBMED, and Cochrane electronic databases. Published bibliographies were manually searched, and unpublished studies were obtained by contacting research groups. Reports were reviewed and abstracted independently by two trained readers. All randomised and observational studies of schistosomiasis morbidity were eligible for inclusion. We calculated pooled estimates of reported disability-related effects using weighted odds ratios for categorical outcomes and standardised mean differences for continuous data.Findings 482 published or unpublished reports (March, 1921, to July, 2002) were screened. Of 135 selected for inclusion, 51 provided data for performance-related symptoms, whereas 109 reported observed measures of disability-linked morbidities. Schistosomiasis was significantly associated with anaemia, chronic pain, diarrhoea, exercise intolerance, and undernutrition.Interpretation By contrast with WHO estimates of 0.5% disability weight assigned to schistosomiasis, 2-15% disability seems evident in different functional domains of a person with schistosomiasis. This raised estimate, if confirmed in formal patient-preference studies, indicates a need to reassess our priorities for treating this silent pandemic of schistosomiasis.